Surgeon controlled endoscope device and method

ABSTRACT

A medical apparatus including an endoscopic tool including first and second members longitudinally slideable relative to each other; and a control connected to a proximal end of the endoscopic tool. The control includes a housing and an actuation mechanism. The actuation mechanism is longitudinally slideably connected to the housing. The actuation mechanism has the first member and/or the second member connected thereto. The housing includes a connector configured to removeably connect the housing to a control section of an endoscope.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of application Ser. No.14/092,199 filed Nov. 27, 2013 and claims priority on U.S. ProvisionalPatent Application No. 61/814,498 filed Apr. 22, 2013 which are herebyincorporated by reference in their entireties.

BACKGROUND Technical Field

The exemplary and non-limiting embodiments relate generally to anendoscope and, more particularly, to an apparatus used with anendoscope.

Brief Description of Prior Developments

U.S. Pat. No. 6,764,499 discloses a medical device with a basket. U.S.Pat. No. 8,211,115 discloses a variable size retrieval basket.

SUMMARY

The following summary is merely intended to be exemplary. The summary isnot intended to limit the scope of the claims.

In accordance with one aspect, a medical apparatus includes anendoscopic tool including first and second members longitudinallyslideable relative to each other; and a control connected to a proximalend of the endoscopic tool. The control includes a housing and anactuation mechanism. The actuation mechanism is longitudinally slideablyconnected to the housing. The actuation mechanism has the first memberand/or the second member connected thereto. The housing includes aconnector configured to removeably connect the housing to a controlsection of an endoscope.

In accordance with another aspect, an example method comprises insertinga distal end of an endoscopic device into a working channel of anendoscope, where the endoscopic device comprises an endoscopic tool,where the endoscopic tool comprises first and second members which arelongitudinally slideable relative to each other; and removeablyconnecting a proximal end of the endoscopic device to a control sectionof the endoscope, where the proximal end comprises a housing and anactuation mechanism, where the actuation mechanism is slideablyconnected to the housing, where the actuation mechanism has the firstmember and/or the second member connected thereto, and where the housingcomprises a connector which removeably connects the housing to thecontrol section of the endoscope.

In accordance with another aspect, an example method comprises providingan endoscopic tool, where the endoscopic tool comprises first and secondmembers which are longitudinally slideable relative to each other; andconnecting a control to a proximal end of the endoscopic tool, where thecontrol comprises a housing and an actuation mechanism, where theactuation mechanism, is longitudinally slideably connected to thehousing, where the actuation mechanism has the first member and/or thesecond member connected thereto, and where the housing comprises aconnector configured to removeably connect the housing to a controlsection of an endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing aspects and other features are explained in the followingdescription, taken in connection with the accompanying drawings,wherein:

FIG. 1 is a side view of an endoscope;

FIG. 2 is a side view of a distal end of an endoscopic tool of anendoscopic device;

FIG. 3A is a side view illustrating extension, of the tool shown in FIG.2 from the distal end of the endoscope shown in FIG. 1;

FIG. 3B is a side view of an alternate embodiment of an endoscopic tool;

FIG. 4A is a plan view of a control of the endoscopic device shown inFIG. 2 with the slider/actuation mechanism in a first position;

FIG. 4B is a plan view as in FIG. 4A with the slider/actuation mechanismin a second position;

FIG. 5A is a plan view of a control of the endoscopic device shown inFIG. 2 with the slider/actuation mechanism in a first position;

FIG. 5B is a plan view as in FIG. 5A with the slider/actuation mechanismin a second position;

FIG. 6 is a schematic illustration of combined features of theinvention;

FIG. 7 is a plan view of the control of the endoscopic device beinglocated on the deflection control of the endoscope;

FIG. 8 is a plan view as in FIG. 7 illustrating movement of theslider/actuation mechanism on the endoscope;

FIG. 9 is a perspective view of the endoscope with a slide-on control;

FIG. 10 is an illustration indicating the endoscopic device control ofFIG. 9 being removably connected to a deflection control of theendoscope;

FIG. 11 is an alternate embodiment of the control shown in FIG. 10 and aportion of the endoscope;

FIG. 12 is a perspective view of an alternate embodiment of the controlshown in FIG. 11;

FIG. 13 is a schematic illustration of another example embodiment of theendoscopic device control;

FIG. 14 is schematic illustration of some of the components of thecontrol shown in FIG. 13;

FIG. 15 is a schematic illustration of another example embodiment of theendoscopic device control;

FIG. 16 is a schematic illustration of another example embodiment of theendoscopic device control;

FIG. 17 is a schematic illustration of another example embodiment of theendoscopic device control; and

FIG. 18 is a schematic illustration of another example embodiment of theendoscopic device control.

FIG. 19 is a schematic illustration of another example embodiment of theendoscopic device control.

FIG. 20 is a schematic illustration of another example embodiment of theendoscopic device control.

FIG. 21 is a schematic illustration of another example embodiment of theendoscopic device control.

FIG. 22 is a schematic illustration of another example embodiment of theendoscopic device control.

FIG. 23 is a schematic illustration of another example embodiment of theendoscope device control.

DETAILED DESCRIPTION OF EMBODIMENTS

Referring to FIG. 1, there is shown a side elevation view of anapparatus 10 incorporating features in an example embodiment. Althoughthe present invention will be described with reference to theembodiments shown in the drawings, it should be understood that thepresent invention can be embodied in many alternate forms ofembodiments. In addition, any suitable size, shape or type of elementsor materials could be used.

The apparatus 10 in this example is an endoscope medical deviceconfigured to be partially inserted into a patient's body, such as inthrough the patient's urethra for example. The endoscope 10 generallycomprises a control section 12 and a flexible or semi-flexible shaft 14connected to the control section 12. The control section 12 forms ahandle for the apparatus. The shaft 14 includes a passive deflectionsection 16 and an active deflection section (bending section) 18 at thedistal end of the shaft 14. A control system 22 to control the activedeflection section 18 extends from the control section 12 to the activedeflection section 18. The control system 22 generally comprises bendingcontrol wires, wire sheaths, and an actuator 28. The wires are connectedto the actuator 28 at one end and are connected to the active deflectionsection 18 at a second end.

In the example embodiment shown, the control section 12 has a useroperated slide or lever (control lever) 30. The lever 30 is connected tothe actuator 28. The actuator 28 is adapted to pull and release thewires of the control system 22. When the lever 30 is moved by the user,the actuator 28 is moved. The actuator 28 may be, for example, a drum orpulley rotatably connected to the control section 12 to pull one wirewhile releasing the other. In an alternate embodiment, the actuator maybe any suitable type of device, such as a rocker arm adapted to pull andrelease the wires of the control system 22. In another alternateembodiment, where the control system may have two or more pairs ofcontrol wires, the control section will have additional actuators andcorresponding controls to drive the additional pairs of bending controlwires. In still other alternate embodiments, the control section maynave knobs with rack and pinion mechanisms or other suitable useroperated controls for the control system.

The shaft 14 is cantilevered from the control section 12. The flexibleshaft 14 includes the bending control wires of the control system 22, afiber optic image bundle, a fiber optic illumination bundle, and aworking channel. A port 60 for inserting instruments into the workingchannel 24 of the shaft is located on the control section 12. Thecontrol section 12 also has a light source post 62 for connecting alight source (not shown) to the illumination bundle. In addition, thecontrol section 12 has an eyepiece 63 for a user to view an imagetransmitted by the image bundle from the front end 20. In alternateembodiments, the flexible shaft may house different systems within. Theshaft 14 generally comprises a frame 26, a cover 32 and an objectivehead 34.

Referring also to FIGS. 2-3A, a distal end of an endoscopic tool 36 isshown. The tool 36 is attached to the apparatus 10 and is configured toextend out of the distal end 20 of the shaft 14 from the working channel24. The tool 36, in this example, is a Surgeon Controlled Basket Device(SCBD). The tool 36 includes an assembly 33 which comprises a basketdevice 50 and a sheath 56. The basket device 50 comprises a basketsection 52 at a distal end, and a shaft section 54 extending through thesheath 56 to a proximal end of the tool 36. The shaft section 54functions as a control wire for moving the basket section 52. The sheath56 and basket device 50 are longitudinally movable relative to eachother to move the basket device 50 between a forward position and arearward position relative to the sheath 56. FIGS. 2 and 3A show theshaft section (control wire) 54 moved forward relative to the sheath 56such that the basket section 52 is located out from a front end aperture66 of the sheath 56. In the forward position of the sheath 56 on thebasket device 50, the basket section 52 is located inside the sheath 56;the basket section 52 being collapsed by the sheath 56 into a smallershape to fit inside the sheath 56.

Referring also to FIGS. 4A, 4B and 6, in this example embodiment thelever 30 is both a deflection control member 70 for the actuator 28 anda tool actuator 72 for the tool 36. A frame 74 of the lever 30 isconnected to the actuator 28 to be able to rotate the actuator 28 as thelever 30 is rotated forward and backward as indicated by arrow 76 inFIG. 7. The tool actuator 72 comprises a slider member 78, or actuationmechanism, which is movably mounted on a slit 100 of a tool actuatorframe 74′ to be able to slide laterally as indicated by arrow 80. Theproximal end 58 of the shaft section 54 is fixedly, but removablyattached to the slider member 78 at location 59. The proximal end 57 ofthe sheath 56 is fixedly, but removably connected to the lever frame 74.

The tool 36 is inserted into the working channel 24 by the user, and theproximal ends 57, 58 of the sheath 56 and shaft section 54 are connectedto the lever frame 74 and the slider member 78, respectively. FIG. 4Ashows the tool actuator 72 at an actuated position which corresponds tothe basket section 52 extending past the front end of the sheath 56 asshown in FIGS. 2 and 3A. FIG. 4B shows the tool actuator 72 at a homeposition which corresponds to the basket section 52 being located insidethe front end of the sheath 56. As can be seen by reviewing FIGS. 4A and4B, the slide member 78 is able to move on the tool actuator frame 74′to move the shaft section (control wire) 54 relative to the sheath 56,thus covering and uncovering the basket section 52 based upon thelocation of the slide member 78 on the tool actuator frame 74′. In onetype of alternate embodiment, as discussed below with respect to theexample of FIGS. 5A-5B, the tool actuator 72 may be configured to movethe sheath 56 relative to the shaft section (control wire) 54.

Referring also to FIGS. 5A-5B an alternate example is shown. In thisexample the lever 30 is also both a deflection control member 70 for theactuator 28 and a tool actuator 72 for the tool 36. A frame 74 of thelever 30 is connected to the actuator 28 to be able to rotate theactuator 28 as the lever 30 is rotated forward and backward as indicatedby arrow 76 in FIG. 7. The tool actuator 72 comprises a slider member 78which is movably mounted on a slit 100 of a tool actuator frame 74′ tobe able to slide laterally as indicated by arrow 80. The proximal end 58of the shaft section 54 is fixedly, but removably attached to the leverframe 74 at location 59. The proximal end 57 of the sheath 56 isfixedly, but removably connected to the slider member 78.

The tool 36 is inserted into the working channel 24 by the user, and theproximal ends 57, 58 of the sheath 56 and shaft section 54 are connectedto the slider member 78 and the lever frame 74, respectively. FIG. 5Ashows the tool actuator 72 at an actuated position which corresponds tothe sheath 56 being retracted on the basket device 50 such that thebasket section 52 extends past the front end of the sheath 56 as shownin FIGS. 2 and 3A. FIG. 5B shows the tool actuator 72 at a home positionwhich corresponds to the basket section 52 being located inside thefront end of the sheath 56. As can be seen by reviewing FIGS. 5A and 5B,the slide member 78 is able to move on the tool actuator frame 74′ tomove the sheath 56 relative to the basket device 50, thus, covering anduncovering the basket section 52 based upon the location of the slidemember 78 on the tool actuator frame 74′.

As seen in FIGS. 7-8, tool 36 extends around the outside of the controlsection 12. The tool 36 is slidably coupled to the working channel 24and/or the port 60 by friction or coupling mechanism. The user maymanually move the tool 36 into and out of the port 60 to extend andretract the front end of the tool 36 relative to the distal end of theshaft 14. In the example shown in FIG. 8, the scope tip is deflected up(lever down) and the basket is not yet deployed out of the sheath (thumbslider to the right). The physician may control both, the scopedeflection and basket activation with his/her single thumb.

As illustrated by FIGS. 9 and 10, this concept could also be designed asan add-on 82 to an existing endoscope 84. In this case, the basketactivation add-on 82 would slide over an existing conventional (ormodified) scope lever 30′. Tool actuator frame 74′ may be slid onto thecantilevered lever frame 74 of the lever 30′.

Referring also to FIG. 3B, in an alternate example, the tool may not bea Surgeon Controlled Basket Device (SCBD). In this example the tool 36′has a tip of the device which is a grasper, or may be any other form ofstone retrieval device. In this example the tool 36′ has a working head50′ and a shaft 54. The tool 36′ would be actuated by the tool actuator72, where the shaft 54 is connected to the tool actuator 72.

Features as described herein may be used for a surgeon controlled basketand scope design; the surgeon being able to use one hand to hold theinsertion portion and the other hand to hold the handle of the endoscopeand control the scope deflection. Conventionally, there is no hand freeto control the basket/ET-device at the same time. For this reason,assistance is required to hold the basket handle and to deploy/retrievethe basket. Features as described herein allow a physician to controlboth, the scope deflection and the basket deployment with one thumb andwithout another person's help. Features as described herein may be usedto provide a combined basket thumb slider and scope lever into oneactuation, mechanism; the lever 30 or 30′. Thus, the lever for the scopedeflection of the distal end may have an integrated thumb slider for thebasket actuation.

Features as described herein may relate to an endoscope, lithotripsydevice, kidney stone retaining basket, grasper, clip-on basket controldevice, and/or rotatable detachable stone basket. Urology lithotripsyand surgery processes require using grasping or biopsy forceps and aretaining basket which operates by a control wire that extends through asheath. Most existing instruments have a slider which moves along ahandle, separate from the handle of the endoscope, operating the devicewith a sliding motion and locking mechanism. Existing devices aredesigned such that more than one person is required to effectivelyconduct a stone retrieval procedure. This is because existing deviceseach require one or two hands to operate, and devices must becoordinated simultaneously to properly perform the procedure. Forexample, one or two hands are required to perform each of the followingfunctions, manipulate and control:

-   -   the endoscope;    -   the irrigation flow rate;    -   accessories such as        -   guidewires,        -   catheters,        -   access sheaths,        -   balloon dilators,        -   graspers,        -   stents,        -   baskets.

For this reason, the primary surgeon is generally supported by a medicalassistant or nurse. Typically the attending surgeon switches between oneand two-handed control of the endoscope and uses the free hand tointermittently perform the other activities listed above, and istherefore unable to effectively control the stone retrieval device atthe same time. The process of capturing kidney stone fragments in abasket may involve:

-   -   locating the fragments with the endoscope,    -   properly positioning the basket and sheath,    -   carefully deploying (opening) the basket such that it does not        move the fragments away so that they need to be located again,    -   rotating the open basket such that the basket wires surround,        the stone fragments,    -   carefully retracting (closing) the basket such that the basket        wires grasp the stone fragments,    -   carefully removing both the endoscope and the basket from the        patient ensuring that the fragments do not get stuck in the        access sheath, or patient's anatomy,    -   and finally releasing the stone fragments from the basket or        graspers outside of the patient's body.

One of the important steps described above is to properly rotate thebasket, for consistent capturing of the stone fragments, withoutaccidentally moving the fragments around or causing them to drop out ofthe retrieval device if possible. In the process of “fishing” andcapturing the kidney stone's fragments they are very often lost when,the basket closes. This happens because, conventionally, the basket ismoving back and the sheath is fixed. Additionally, sometimes stonefragments start to obscure the physician's vision while breaking up alarger stone, so instruments are switched in and out of the workingchannel to intermittently break up stones and retrieve fragments. Thisrequires that the stone retrieval device be capable of quickly beingexchanged with a lithotripsy or other accessory.

Features as described herein were designed for one hand control of theendoscope and stone retrieval device. The surgeon, can hold both theendoscope and the basket control device using only one hand. The secondhand can be used for additional manipulation, changing and adjustingaccessories and irrigation using syringe or liquid container adaptervalve. Basically it permits the surgeon to perform the entire procedurewithout additional specialists' support. The device allows the sheath tomove with, a fixed basket, or moves both the sheath and basketsimultaneously while opening and closing. This feature reduces thepossibility of losing fragments of stones during the basket closingprocess. It also supports the rotation of the stone retrieval devicewith the same hand, quick removal and detachment from the endoscope, andquick insertion and reattachment to the endoscope.

Referring also to FIG. 11, a portion of a control section 12 of anendoscope 100 is shown with another example embodiment. The endoscope100 includes a working port entrance 60 and a deflection control lever30′. The endoscopic device 102 comprises the endoscopic tool 36 and thecontrol 104. The endoscopic tool 36 is the same as described above withthe sheath 56 and the basket device 50. The control 104 comprises ahousing 106 and a slider 108, or actuation mechanism. The housing 106includes a connector 110 which is sized and shaped to snap on to thedeflection control lever 30′. The sheath and the basket device formfirst and second members which the slider 108 may be attached to. Theslider is longitudinally mounted on the housing 106 to slide back andforth as indicated by arrow 112 to longitudinally move the sheath andbasket device relative to each other between an extended position and aretracted position.

Referring also to FIG. 12, an example embodiment similar to that of FIG.11 is shown. However, in this example a rotating connector 114 is addedas a connection of the proximal end of the endoscopic device 36 to thecontrol 104. FIG. 12 is a view of a rotating version of the surgeoncontrolled stone retrieval device (SCRD) with a clip-on or slide-oncoupling feature to the endoscope deflection lever. In the example,sliding the lever 108 to the left would deploy the stone retrievaldevice, and sliding the lever 108 to the right could retract the stoneretrieval device. Since the entire SCRD assembly is rigidly, butremovably coupled to the endoscope deflection lever 30′, pushing thecontrol 104 up or pulling the control 104 down also moves the endoscopedeflection lever 30 up and down respectively. The same thumb used toboth deflect the endoscope at lever 30′ and deploy or retract the stoneretrieval device at slider 108 can also be used to rotate the endoscope100 while in the patient. Deploying or opening the stone retrievaldevice means exposing the stone retrieval portion 52 of the retrievaltool 36. Retracting or closing the stone retrieval tool 36 means causingthe retrieval portion 52 of the retrieval tool 36 to retract back intoits sheath 56, or to “capture” targeted stone fragments. Neither ofthese terms are meant to restrict the mechanism of relative motionbetween the sheath and the retrieval portion of the retrieval device. Asfurther understood from the examples described below, the retrievalportion may be moved relative to a stationary sheath, the sheath may bemoved relative to a stationary basket, or both the retrieval portion andthe sheath may be moved simultaneously relative to each other.

Referring also to FIGS. 13-14, an alternate example embodiment of thecontrol of the endoscopic device is shown. In this example the control116 comprises a housing 118, a slider 120 (actuation mechanism) and atransmission 122. The housing 118 may have a connector such as theconnector 110 or the connector 74′ for example. The transmission 122comprises a rack section 124 on the slider 120, a pinion section 126connected to a worm gear 128, and a worm gear follower 130. The proximalend of the shaft section 54 is connected to the worm gear follower 130.As the slider 120 is longitudinally moved on the housing 118 indirections 112, the rack section 124 causes the pinion section 126 torotate as indicated by arrow 132. Rotation of the pinion section 126causes the worm gear 128 to axially rotate which, in turn, causes thefollower 130 to longitudinally move as indicated by arrow 134. When thefollower 130 moves, the shaft section 54 of the basket device islongitudinally moved relative to the sheath 56. In an alternate example,any suitable transmission may be provided.

Referring also to FIG. 15, another alternate example embodiment isshown. In this example the endoscopic device comprises the endoscopiccool 36 and a control 136. The control 136 includes a housing 138, aslider 140 (actuation mechanism) and a transmission 142. The housing 138may have a connector such as the connector 110 or the connector 74′ forexample. The transmission 142 includes a pivot arm 144 connected to thehousing 138 by a pivotable connection 146. Opposite ends of the pivotarm 144 are connected to the slider 140 and the proximal end of thesheath 56. The proximal end of the shaft section 56 is fixed to thehousing 138. As the slider 140 is longitudinally moved as indicated byarrow 112, the proximal end of the sheath 56 is longitudinally movedrelative to the shaft section 54 to thereby move the endoscopic toolbetween its extended configuration and its retracted configuration. Whenthe proximal end of the sheath 56 is at P₀, the shaft is located overthe basket section. When the proximal end of the sheath 56 is at P₁, thebasket section is exposed to an enlarged position in front of the distalend of the sheath.

Referring also to FIG. 16, another alternate example embodiment isshown. In this example the endoscopic device comprises the endoscopictool 36 and a control 148. The control 148 includes a housing 150, aslider 152 (actuation mechanism) and a transmission 154. The housing 150may have a connector such as the connector 110 or the connector 74′ forexample. The proximal end of the sheath 56 is stationarily connected tothe housing 150. The transmission 154 includes a “V” spring 156. One endof the V spring 156 is stationarily connected to the housing and theother end of the V spring 156 is connected to the shaft section 54 ofthe endoscopic tool 36. FIG. 16 shows the V spring, shaft section 54 andslider 152 at a home position P₀. When the proximal end of the basketdevice 50 is at P₀, the shaft is located over the basket section. Whenthe slider 152 is moved, the end 158 of the slider can deflect the Vspring 156 to position P₁ which moves the basket device 50 to positionP₁. When the proximal end of the basket device 50 is at P₁, the basketsection is exposed to an enlarged position in front of the distal end ofthe sheath.

Referring also to FIG. 17, another alternate example embodiment isshown. In this example the endoscopic device comprises the endoscopictool 36 and a control 160. The control 160 includes a housing 150, aslider 152 and a transmission 154. The housing 150 may have a connectorsuch as the connector 110 or the connector 74′ for example. The proximalend of the shaft section 54 is stationarily connected to the housing150. The transmission 154 includes a “V” spring 156. One end of the Vspring 156 is stationarily connected to the housing and the other end ofthe V spring 156 is connected to the sheath 56 of the endoscopic tool36. FIG. 17 shows the V spring, shaft section 54 and slider 152 atposition P₀. When the proximal end of the sheath 56 is at P₀, the basketsection is exposed to an enlarged position in front of the distal end ofthe sheath. When the slider 152 is moved, the end 158 of the slider candeflect the V spring 156 to move the sheath 56 to position P₁. At P₁,the shaft is located over the basket section. In the example embodimentof FIG. 17 the sheath 56 is longitudinally moved relative to the basketdevice 50, and in the example embodiment of FIG. 16 the basket device 50is longitudinally moved relative to the sheath 56. In FIG. 18, both thebasket device 50 and the sheath 56 are longitudinally moved relative tothe housing 150.

As seen in FIG. 18, in this example the endoscopic device comprises theendoscopic tool 36 and a control 162. The control 162 includes a housing150, a slider 152 and a transmission 164. The housing 150 may have aconnector such as the connector 110 or the connector 74′ for example.The transmission 164 includes a “V” spring 156. The proximal end of theshaft section 54 is connected to the V spring 156. The proximal end ofthe sheath 56 is connected to the other end of the V spring 156. As theslider 152 is moved to straighten the V spring 156, the basket device 50is moved forward and the sheath is moved backward from P₀ to P₁.

It is contemplated that additional alternative embodiments may be usedfor actuation of the sheath and the basket device. Such a device may beremovably attached to an endoscope lever such that control of theendoscope tip deflection as well as control of movement of the basketand sheath might be possible with a single finger of a user. Forexample, control cables for controlling basket device and sheathmovement may be connected directly to the actuation mechanism. It iscontemplated that the actuation mechanism may be other than a thumbslider. By way of example, the actuation mechanism may be a joystickcontrol, a rotating wheel, a set of rotating wheels, a pivotable rod, apush rod, a drum pivot with control cables wrapped around it. Theactuation mechanisms described may be removably attached to the controllever of the endoscope handle, for example.

An example embodiment is illustrated in FIG. 19 showing a set ofrotating wheels 170 and 171 being used for actuating a basket 54 andsheath 56. A control cable for controlling movement of the sheath 56 maybe connected to one wheel at point 181, for example, and a control cablefor controlling movement of basket 54 may be connected to another wheelat a point 180. A locking mechanism may include a slider 172 whichconnects into a lock 73 may be provided for the two wheels 170 and 171to allow for basket 54 and sheath 56 to be moved simultaneously whendesired, providing for increased flexibility and control over the basketand sheath actuation. FIG. 20 shows an example embodiment of a set ofrotating wheels for actuating a basket and sheath located on adetachable mechanism for attaching to the control lever of an endoscope,with a rotation function additionally provided for rotating the basketand sheath assembly.

An example embodiment is illustrated in FIG. 21 showing joystickactuation for controlling actuation of a basket and a sheath. Joystick195 can be moved in a first direction, 190, or a second direction 191.Moving joystick 195 in a first direction 190 causes a rotation about apivot point 193 causing movement of basket 54. Moving joystick 195 in asecond direction 191 causes movement about a second pivot point andmovement of a block 203 via linkage 194. This movement in turn causessliding of a roller 204 which actuates movement of sheath 56. Moving ajoystick controller from left to right, for example, might controlmovement of the basket and moving the joystick up and down might controlmovement of the sheath. FIG. 22 shows an example embodiment of ajoystick mechanism for actuating a basket and sheath located on adetachable mechanism for attaching to the control lever of an endoscope,with a rotation function additionally provided for rotating the basketand sheath assembly. Such a mechanism would allow for movement of thedeflection of the endoscope distal end, actuation of a basket andactuation of a sheath with a single finger of a user.

FIG. 23 shows an example embodiment of an alternative joystick mechanismfor actuating a basket and sheath located on a detachable mechanism forattaching to the control lever of an endoscope, with a rotation functionprovided, for rotating the basket and sheath assembly. Joystick 195 canbe moved in a first direction, 190, or a second direction 191. In thisembodiment, a stiff flexible cable 210 would connect to the pivot block211 through a pivot joint 212 and be routed through a bended conduit.The conduit is bent through 90 degrees. This would translate theside-to-side motion of the pivot block into a linear in-out motion toactuate the sheath. Moving a joystick controller from left to right, forexample, might control movement of the basket and moving the joystick upand down might control movement of the sheath.

It is additionally contemplated that a robotic actuation mechanism maybe used for controlling movement of the basket and sheath or forcontrolling movement of a basket, a sheath, and deflection of anendoscope distal end. For example, electrical motors may be utilised todrive motion when actuation levers, dials, or joysticks are actuated.

In one type of example embodiment, a medical apparatus comprises anendoscope comprising a bending portion and a handle portion; anendotherapy device having an effecter part and at least one control wireconnected to the effecter part; a coupling portion connecting theendotherapy device to the endoscope, wherein the coupling portion isconfigured to extend the control wire along a surface of the handleportion; a control lever located at the handle portion and configured tolinearly move in a first direction for controlling the bending section;and a slider located and configured to linearly move in a seconddirection on the control lever, wherein the slider includes a connectingportion configured to connect a proximal end of the control wire forcontrolling the effecter part.

In one type of example embodiment a medical apparatus comprises anendoscopic tool comprising first and second members longitudinallyslideable relative to each other; and a control connected to a proximalend of the endoscopic tool, where the control comprises a housing and aslider, where the slider is longitudinally slideably connected to thehousing, where the slider has the first member and/or the second memberconnected thereto, and where the housing comprises a connectorconfigured to removeably connect the housing to a control section of anendoscope.

The first member may comprise a sheath and the second member comprisesbasket device. A proximal end of the sheath may be connected to theslider and a proximal end of the basket device is connected to thehousing. A proximal end of the basket device may be connected to theslider and a proximal end of the sheath is connected to the housing. Theconnector may be sized and shaped to longitudinally slide on to adeflection control lever of the control section of the endoscope. Theconnector may be sized and shaped to resiliently snap on to a deflectioncontrol lever of the control section of the endoscope. A connection ofthe first member and/or the second member to the slider may comprise arack and pinion configuration. A connection of the first member and/orthe second member to the slider may comprise a pivoting member. Aconnection of the first member and/or the second member to the slidermay comprise a spring member. The spring member may comprise a “V”shape.

An example method may comprise inserting a distal end of an endoscopicdevice into a working channel of an endoscope, where the endoscopicdevice comprises an endoscopic tool, where the endoscopic tool comprisesfirst and second members which are longitudinally slideable relative toeach other; and removeably connecting a proximal end of the endoscopicdevice to a control section of the endoscope, where the proximal endcomprises a housing and a slider, where the slider is slideablyconnected to the housing, where the slider has the first member and/orthe second member connected thereto, and where the housing comprises aconnector which removeably connects the housing to the control sectionof the endoscope.

The first member may comprise a sheath and the second member comprisesbasket device, where inserting the distal end of the endoscopic deviceinto the working channel of the endoscope comprises inserting distalends of the sheath and the basket device into the working channel.Removeably connecting the proximal end of the endoscopic device to thecontrol section of the endoscope may comprise longitudinally sliding thehousing on to a deflection control lever of the control section of theendoscope. Removeably connecting the proximal end of the endoscopicdevice to the control section of the endoscope may comprise resilientlysnapping the housing onto to a deflection control lever of the controlsection of the endoscope.

An example method, may comprise providing an endoscopic tool, where theendoscopic tool comprises first and second members which arelongitudinally slideable relative to each other; and connecting acontrol to a proximal end of the endoscopic tool, where the controlcomprises a housing and a slider, where the slider is longitudinallyslideably connected to the housing, where the slider has the firstmember and/or the second member connected thereto, and where the housingcomprises a connector configured to removeably connect the housing to acontrol section of an endoscope.

A proximal end of the first member may be connected to the slider and aproximal, end of the second member is connected to the housing. Theconnector may be sized and shaped to longitudinally slide on to adeflection control lever of the control section of the endoscope. Theconnector may be sized and shaped to resiliently snap on to a deflectioncontrol lever of the control section, of the endoscope.

An example embodiment may be provided in a medical apparatus comprisingan endoscopic tool comprising first and second members longitudinallyslideable relative to each other; and a control connected to a proximalend of the endoscopic tool, where the control comprises a housing and anactuation mechanism, where the actuation mechanism is connected to thehousing, where the actuation, mechanism has the first member and/or thesecond member connected thereto, and where the housing comprises aconnector configured to removeabiy connect the housing to a deflectioncontrol lever of an endoscope.

The first member may comprise a sheath and the second member comprisesbasket device. A proximal end of the sheath may be connected to theactuation mechanism and a proximal end of the basket device is connectedto the housing. A proximal end of the basket device may be connected tothe actuation mechanism and a proximal end of the sheath is connected tothe housing. The connector may be sized and shaped to longitudinallyslide onto the deflection control lever of a control section of theendoscope. The connector may be sized and shaped to resiliently snaponto the deflection control lever of a control section of the endoscope.A connection of the first member and/or the second member to theactuation mechanism may comprise a rack and pinion configuration. Aconnection of the first, member and/or the second member to theactuation mechanism may comprise a pivoting member. A connection of thefirst member and/or the second member to the actuation mechanism maycomprise a spring member. The spring member may comprise a “V” shape.

An example method may comprise inserting a distal end of an endoscopicdevice into a working channel of an endoscope, where the endoscopicdevice comprises an endoscopic tool, where the endoscopic tool comprisesfirst and second members which are longitudinally slideable relative toeach other; and removeably connecting a proximal, end of the endoscopicdevice to a deflection control, lever of a control section of theendoscope, where the proximal end comprises a housing and an actuationmechanism, where the actuation mechanism is slideably connected to thehousing, where the actuation mechanism has the first member and/or thesecond, member connected thereto, and where the housing comprises aconnector which removeably connects the housing to the control sectionof the endoscope.

The first member may comprise a sheath and the second member comprisesbasket device, where inserting the distal end of the endoscopic deviceinto the working channel of the endoscope comprises inserting distalends of the sheath and the basket device into the working channel.Removeably connecting the proximal end of the endoscopic device to thedeflection control lever of the control section of the endoscope maycomprise longitudinally sliding the housing on to the deflection controllever. Removeably connecting the proximal end of the endoscopic deviceto the deflection control lever of the control section of the endoscopemay comprise resiliently snapping the housing onto to the deflectioncontrol lever.

An example method may comprise providing an endoscopic tool, where theendoscopic tool comprises first and second members which arelongitudinally slideable relative to each other; and connecting acontrol to a proximal end of the endoscopic tool, where the controlcomprises a housing and an actuation mechanism, where the actuationmechanism is longitudinally slideably connected to the housing, wherethe actuation mechanism has the first member and/or the second memberconnected thereto, and where the housing comprises a connectorconfigured to removeably connect the housing to a deflection controllever of a control section of an endoscope.

A proximal end of the first member may be connected to the actuationmechanism and a proximal end of the second member may be connected tothe housing. The connector may be sized and shaped to longitudinallyslide onto the deflection control lever of the control section of theendoscope. The connector may be sized and shaped to resiliently snaponto the deflection control lever of the control section of theendoscope.

An example embodiment may be provided in a medical apparatus comprisingan endoscope comprising a bending portion and a handle portion; anendotherapy device having an effecter part and at least one control wireconnected to the effecter part; a coupling portion connecting theendotherapy device to the endoscope, wherein the coupling portion isconfigured to extend the control wire along a surface of the handleportion; a control lever located at the handle portion and configured tolinearly move in a first direction for controlling the bending section;and an actuation mechanism located and configured to linearly move in asecond direction on the control lever, wherein the actuation mechanismincludes a connecting portion configured to connect a proximal end ofthe control wire for controlling the effecter part.

An example embodiment may be provided in a medical apparatus comprisingan endoscopic tool comprising first and second members longitudinallyslideable relative to each other; and a control connected to a proximalend of the endoscopic tool, where the control comprises a housing and anactuation mechanism, where the actuation mechanism is connected to thehousing, where the actuation mechanism has the first member and/or thesecond member connected thereto, and where the housing comprises aconnector configured to removeably connect the housing to a deflectioncontrol lever of an endoscope, wherein the actuation mechanism is ajoystick control which is capable of movement in a first direction andcapable of movement in a second direction, wherein movement in a firstdirection provides actuation of a first member and wherein movement in asecond direction provides actuation of a second member. The joystickcontrol may be connected to a stiff flexible cable routed through aconduit for actuation of a first member through movement of the joystickin a first direction.

An example method may comprise inserting a distal end of an endoscopicdevice into a working channel of an endoscope, where the endoscopicdevice comprises an endoscopic tool, where the endoscopic tool comprisesfirst and second members which are longitudinally slideable relative toeach other; and removeably connecting a proximal end of the endoscopicdevice to a deflection control lever of a control section of theendoscope, where the proximal end comprises a housing and an actuationmechanism, where the actuation mechanism is slideably connected to thehousing, where the actuation mechanism has the first member and/or thesecond member connected thereto, and where the housing comprises aconnector which removeably connects the housing to the control sectionof the endoscope, wherein the actuation mechanism is a joystick controlwhich is capable of movement in a first direction and capable ofmovement in a second direction, wherein movement in a first directionprovides actuation of a first member and wherein movement in a seconddirection provides actuation of a second member.

An example method may comprise providing an endoscopic tool, where theendoscopic tool comprises first and second members which arelongitudinally slideable relative to each other; and connecting acontrol to a proximal end of the endoscopic tool, where the controlcomprises a housing and an actuation mechanism, where the actuationmechanism is longitudinally slideably connected to the housing, wherethe actuation mechanism has the first member and/or the second memberconnected thereto, and where the housing comprises a connectorconfigured to removeably connect the housing to a deflection controllever of the control section of an endoscope, wherein the actuationmechanism is a joystick control which is capable of movement in a firstdirection and capable of movement in a second direction, whereinmovement in a first direction provides actuation of a first member andwherein movement in a second direction provides actuation of a secondmember.

It should be understood that the foregoing description is onlyillustrative. Various alternatives and modifications can be devised bythose skilled in the art. For example, features recited in the variousdependent claims could be combined with each other in any suitablecombination(s). In addition, features from different embodimentsdescribed above could be selectively combined into a new embodiment.Accordingly, the description is intended to embrace all suchalternatives, modifications and variances which fall within the scope ofthe appended claims.

What is claimed is:
 1. A medical apparatus comprising: an endoscopictool comprising first and second members longitudinally slideablerelative to each other; and a control connected to a proximal end of theendoscopic tool, where the control comprises a housing and an actuationmechanism, where the actuation mechanism is connected to the housing,where the actuation mechanism has the first member and/or the secondmember connected thereto, and where the housing comprises a connectorconfigured to removeably connect the housing to a deflection controllever of an endoscope, where the actuation mechanism is configured toslide laterally between lateral sides of the endoscope, where theconnector is sized and shaped to resiliently snap onto the deflectioncontrol lever of a control section at an exterior handle portion of theendoscope.
 2. A medical apparatus as in claim 1 where the connector issized and shaped to longitudinally slide on to the deflection controllever of a control section of the endoscope.
 3. A medical apparatus asin claim 1 where a connection of the first member and/or the secondmember to the actuation mechanism comprises a rack and pinionconfiguration.
 4. A medical apparatus as in claim 1 where a connectionof the first member and/or the second member to the actuation mechanismcomprises a pivoting member.
 5. A medical apparatus as in claim 1 wherea connection of the first member and/or the second member to theactuation mechanism comprises a spring member.
 6. A medical apparatus asin claim 5 where the spring member comprises a “V” shape.
 7. Anapparatus comprising: an endoscope; and a medical apparatus as in claim1 connected to the endoscope.
 8. A medical apparatus comprising: anendoscope comprising a bending portion and a handle portion; anendotherapy device having an effecter part and at least one control wireconnected to the effecter part; a coupling portion connecting theendotherapy device to the endoscope, wherein the coupling portion isconfigured to extend the control wire along a surface of the handleportion; a control lever located at the handle portion and configured tolinearly move in a first direction for controlling bending of thebending section; and an actuation mechanism located directly on thecontrol lever and configured to linearly slide in a second direction onthe control lever, where the second direction in a lateral direction andis orthogonal to the first direction such that the actuation mechanismis configured to slide laterally between lateral sides of the endoscope,wherein the actuation mechanism includes a connecting portion configuredto connect a proximal end of the control wire for controlling theeffecter part.
 9. A medical apparatus as in claim 8 where the couplingportion comprises a housing for the actuation mechanism, where thehousing comprises a connector configured to removeably connect thehousing to the control lever.
 10. A medical apparatus as in claim 8where the effector part comprises a sheath, and where the at least onecontrol wire comprises a basket device at a distal end of the controlwire, where the sheath and the at least one control wire are slidablylocated on one another.
 11. A medical apparatus as in claim 10 where aproximal end of the sheath is connected to the actuation mechanism and aproximal end of the at least one control wire is connected to a housingfor the actuation mechanism.
 12. A medical apparatus as in claim 10where a proximal end of the at least one control wire is connected tothe actuation mechanism and a proximal end of the sheath is connected toa housing for the actuation mechanism.
 13. A medical apparatus as inclaim 8 where the effector part comprises a basket section at a distalend of the at least one control wire, and the endotherapy device furthercomprises a sheath on the control wire, where the sheath and theendotherapy device are linearly slidable relative to one another for thesheath to allow opening and closing of the basket section.
 14. A medicalapparatus as in claim 13 where the endotherapy device is connected tothe actuation mechanism to provide: the proximal end of the at least onecontrol wire being stationary on a housing for the actuation mechanismas the connecting portion and a proximal end of the sheath being movableby the actuation mechanism, or the proximal end of the sheath beingstationary on the actuation mechanism and the proximal end of thecontrol wire being movable by the actuation mechanism.
 15. A medicalapparatus as in claim 13 where the endotherapy device is connected tothe actuation mechanism to provide: the proximal end of the at least onecontrol wire being movable by the actuation mechanism, and a proximalend of the sheath being movable by the actuation mechanism, and theproximal end of the control wire and the proximal end of the sheathbeing movable relative to each other, where the sheath and the at leastone control wire are linearly slidable relative to one another.
 16. Amedical apparatus as in claim 8 where the actuation mechanism isconnected to the control lever to move with the control lever in thefirst direction and the actuation mechanism is connected to the controllever to move relative to the control lever in the second direction.